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(Circulation. 2000;102:123.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Ventricular Tachycardia

A Complication of an Intramyocardial Echinococcal Cyst

Michael T. Johnstone, MD; Michael Notarianni, MD; Mark Charlamb, MD; Carl Rasmussen, MD, PhD; William Quist, MD; Sidney Levitsky, MD

From the Departments of Medicine (Cardiovascular Division; M.N., M.T.J., M.C., C.R.), Pathology (W.Q.), and Surgery (S.L.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass.

Correspondence to Michael T. Johnstone, MD, Beth Israel Deaconess Medical Center, Cardiovascular Division, Kennedy Building, Fifth Floor, 1 Autumn St, Boston, MA 02215. E-mail mjohnst1{at}caregroup.harvard.edu

A23-year-old man originally from Angola presented to an outlying hospital with a 1-day history of palpitations, dyspnea, and near-syncope. In the ambulance, he developed recurrent ventricular tachycardia. In the emergency room, he was started on intravenous metoprolol and amiodarone. His physical examination was within normal limits. His ECG showed underlying normal sinus rhythm with runs of ventricular tachycardia (Figure 1). His laboratory values were significant for a white blood cell count of 17.4x10³/µL with no eosinophilia. Serology was negative for both Echinococcus and Cysticercosis.

View larger version (128K): [in this window] [in a new window]   Figure 1. A 12-lead ECG showing normal sinus rhythm with a run of ventricular tachycardia.

The transesophageal echocardiogram (Figure 2) showed a large, echolucent cyst that compressed the anterior free wall of the left ventricle. A CT scan of the thorax (Figure 3) demonstrated an 8x7x6.5-cm cystic lesion on the dorsal aspect of the aortic root and the anterolateral aspect of the left ventricle. The patient was referred to cardiothoracic surgery for resection of a presumed pericardial cyst by lateral thoracotomy. After careful inspection in the operating room, the cyst was found to be intramyocardial. The operation was aborted once it was decided that a safer approach for such a cyst would be a median sternotomy with the patient on cardiac bypass. This was performed 2 days later. In the operating room, the cyst was carefully isolated, infused with 3% normal saline, and surgically resected (Figure 4). Pathological analysis of the contents of the cyst was positive for scolices (Figures 5 and 6) diagnostic of Echinococcus. The patient was started on albendazole, and his white blood cell count declined. Since his discharge from hospital, the patient has remained free of ventricular tachycardia.

View larger version (115K): [in this window] [in a new window]   Figure 2. Transesophageal echocardiogram from transgastric view showing large hydatid cyst (CYST) adjacent to anterior free wall of left ventricle (LV) with internal trabeculations. LA indicates left atrium.

View larger version (110K): [in this window] [in a new window]   Figure 3. CT scan showing large, lucent cystic structure (Cyst) in left hemithorax adjacent to anterior free wall of left ventricle (LV). LA indicates left atrium; RA, right atrium; RVOT, right ventricular outflow tract; AAo, ascending aorta; and DAo, descending aorta.

View larger version (135K): [in this window] [in a new window]   Figure 4. Gross pathological specimen of hydatid cyst removed from left hemithorax.

View larger version (130K): [in this window] [in a new window]   Figure 5. Two protoscolices found within mature hydatid cyst (hematoxylin/eosin staining; magnification x400).

View larger version (140K): [in this window] [in a new window]   Figure 6. Wet mount of a protoscolex showing hooklets.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Johnstone, M. T. Articles by Levitsky, S. Search for Related Content PubMed PubMed Citation Articles by Johnstone, M. T. Articles by Levitsky, S. Related Collections Myocardial cardiomyopathy disease Other etiology Arrhythmias, clinical electrophysiology, drugs